NUR 242 Exam 3 () | Med-
Surg Nursing | Galen College (A+
Guarantee) | PDF
SECTION 1: RESPIRATORY DISORDERS (Questions 1-25)
Q1. The nurse understands that which of the following is the most
common symptom of pneumonia in the older adult patient?
A. Fever
B. Cough
C. Confusion
D. Weakness
Answer: C) Confusion
Rationale: The older adult with pneumonia often has weakness, fatigue, lethargy,
confusion, and poor appetite. Fever and cough may be absent, but hypoxemia is usually
present. The most common manifestation of pneumonia in the older adult patient
is confusion from hypoxia rather than fever or cough .
Q2. A patient with pneumonia has a temperature of 39.2°C
(102.6°F), respiratory rate of 30/min, and oxygen saturation of
88%. Which finding is the priority?
A. Fever
B. Tachypnea with hypoxemia
,C. Reduced appetite
D. Fatigue
Answer: B) Tachypnea with hypoxemia
Rationale: Impaired oxygenation and respiratory compromise take priority under
the ABC (Airway, Breathing, Circulation) framework. Oxygen saturation of 88%
indicates significant hypoxemia requiring immediate intervention .
Q3. A patient with pneumonia has an oxygen saturation of 88%.
The provider orders: IV fluids, oxygen at 2 L per nasal cannula,
blood cultures × 3, urinalysis, and cefazolin IVP every 8 hours.
Which order should the nurse implement first?
A. IV fluids 1000 mL .9 NS at 60 mL/hr
B. Oxygen at 2 L per nasal cannula
C. Blood cultures and urinalysis
D. Cefazolin 1 g IVP every 8 hours
Answer: B) Oxygen at 2 L per nasal cannula
Rationale: Hypoxia is a priority concern in pneumonia. Oxygen therapy should be
started as soon as possible. Blood cultures should be obtained before antibiotics are
administered, but oxygen takes priority .
Q4. A patient with COPD has a barrel chest appearance. Which
assessment findings should the nurse expect to see?
,A. Bradycardia and hypotension
B. Shortness of breath, use of accessory muscles, forward posture, and barrel chest
C. Decreased respiratory rate and shallow breathing
D. Absence of cough and sputum production
Answer: B) Shortness of breath, use of accessory muscles, forward posture, and
barrel chest
Rationale: Patients with COPD often have a barrel chest appearance, are short of
breath, and may use accessory muscles when breathing. These patients tend to move
slowly, are slightly stooped, and may sit in a forward-bending (tripod) posture to
improve breathing .
Q5. A patient with COPD is receiving oxygen therapy. Which
nursing principle is most appropriate?
A. High-flow oxygen to maintain saturation > 95%
B. Low-flow oxygen to prevent loss of hypoxic drive
C. Oxygen is not indicated for COPD patients
D. Oxygen should be delivered via non-rebreather mask
Answer: B) Low-flow oxygen to prevent loss of hypoxic drive
Rationale: In some COPD patients, the primary respiratory drive is hypoxia rather than
hypercapnia. High-flow oxygen can eliminate this drive, leading to respiratory
depression and CO₂ retention. Low-flow oxygen should be used to maintain oxygen
saturation between 88-92% .
, Q6. Which clinical manifestations would the nurse expect to see
when assessing a patient with COPD? (Select all that apply)
A. Bradycardia
B. Shortness of breath
C. Use of accessory muscles
D. Sitting in a forward posture
E. Barrel chest appearance
Answer: B, C, D, E
Rationale: The patient with COPD often has a barrel chest appearance, is short of
breath, and may use accessory muscles when breathing. These patients tend to move
slowly and are slightly stooped. Usually they sit with a forward-bending posture. With
severe dyspnea, they exhibit activity intolerance .
Q7. A client with COPD has an oxygen saturation of 86% on 2
L/min oxygen. The nurse increases oxygen to 3 L/min. Thirty
minutes later, the client is lethargic and confused. What is the
probable cause?
A. Carbon dioxide narcosis
B. Increased intracranial pressure
C. Acute asthma exacerbation
D. Pulmonary embolism
Answer: A) Carbon dioxide narcosis
Surg Nursing | Galen College (A+
Guarantee) | PDF
SECTION 1: RESPIRATORY DISORDERS (Questions 1-25)
Q1. The nurse understands that which of the following is the most
common symptom of pneumonia in the older adult patient?
A. Fever
B. Cough
C. Confusion
D. Weakness
Answer: C) Confusion
Rationale: The older adult with pneumonia often has weakness, fatigue, lethargy,
confusion, and poor appetite. Fever and cough may be absent, but hypoxemia is usually
present. The most common manifestation of pneumonia in the older adult patient
is confusion from hypoxia rather than fever or cough .
Q2. A patient with pneumonia has a temperature of 39.2°C
(102.6°F), respiratory rate of 30/min, and oxygen saturation of
88%. Which finding is the priority?
A. Fever
B. Tachypnea with hypoxemia
,C. Reduced appetite
D. Fatigue
Answer: B) Tachypnea with hypoxemia
Rationale: Impaired oxygenation and respiratory compromise take priority under
the ABC (Airway, Breathing, Circulation) framework. Oxygen saturation of 88%
indicates significant hypoxemia requiring immediate intervention .
Q3. A patient with pneumonia has an oxygen saturation of 88%.
The provider orders: IV fluids, oxygen at 2 L per nasal cannula,
blood cultures × 3, urinalysis, and cefazolin IVP every 8 hours.
Which order should the nurse implement first?
A. IV fluids 1000 mL .9 NS at 60 mL/hr
B. Oxygen at 2 L per nasal cannula
C. Blood cultures and urinalysis
D. Cefazolin 1 g IVP every 8 hours
Answer: B) Oxygen at 2 L per nasal cannula
Rationale: Hypoxia is a priority concern in pneumonia. Oxygen therapy should be
started as soon as possible. Blood cultures should be obtained before antibiotics are
administered, but oxygen takes priority .
Q4. A patient with COPD has a barrel chest appearance. Which
assessment findings should the nurse expect to see?
,A. Bradycardia and hypotension
B. Shortness of breath, use of accessory muscles, forward posture, and barrel chest
C. Decreased respiratory rate and shallow breathing
D. Absence of cough and sputum production
Answer: B) Shortness of breath, use of accessory muscles, forward posture, and
barrel chest
Rationale: Patients with COPD often have a barrel chest appearance, are short of
breath, and may use accessory muscles when breathing. These patients tend to move
slowly, are slightly stooped, and may sit in a forward-bending (tripod) posture to
improve breathing .
Q5. A patient with COPD is receiving oxygen therapy. Which
nursing principle is most appropriate?
A. High-flow oxygen to maintain saturation > 95%
B. Low-flow oxygen to prevent loss of hypoxic drive
C. Oxygen is not indicated for COPD patients
D. Oxygen should be delivered via non-rebreather mask
Answer: B) Low-flow oxygen to prevent loss of hypoxic drive
Rationale: In some COPD patients, the primary respiratory drive is hypoxia rather than
hypercapnia. High-flow oxygen can eliminate this drive, leading to respiratory
depression and CO₂ retention. Low-flow oxygen should be used to maintain oxygen
saturation between 88-92% .
, Q6. Which clinical manifestations would the nurse expect to see
when assessing a patient with COPD? (Select all that apply)
A. Bradycardia
B. Shortness of breath
C. Use of accessory muscles
D. Sitting in a forward posture
E. Barrel chest appearance
Answer: B, C, D, E
Rationale: The patient with COPD often has a barrel chest appearance, is short of
breath, and may use accessory muscles when breathing. These patients tend to move
slowly and are slightly stooped. Usually they sit with a forward-bending posture. With
severe dyspnea, they exhibit activity intolerance .
Q7. A client with COPD has an oxygen saturation of 86% on 2
L/min oxygen. The nurse increases oxygen to 3 L/min. Thirty
minutes later, the client is lethargic and confused. What is the
probable cause?
A. Carbon dioxide narcosis
B. Increased intracranial pressure
C. Acute asthma exacerbation
D. Pulmonary embolism
Answer: A) Carbon dioxide narcosis
